Severe Sepsis Resuscitation Protocol: Non-Invasive

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Severe Sepsis Resuscitation Protocol: Non-Invasive Septic Patient with Lactate ≥ 4 mmol/L or MAP < 65 after 2 liters crystalloid WHO AND Goals of care are curative • Administer 20-30 ml/kg isotonic crystalloid bolus over 20 minutes INITIAL • Send cultures of all likely sources of infection • Think of source control (Infected catheter? Operative intervention for infection? Drainable pus?) RESUSCITATION • Administer antibiotics to cover all likely sources of infection If patient’s O2 saturation is < 90% on high fiO supplemental oxygen (non-rebreather mask), consider 2 SpO2 intubation and switching to invasive strategy. Choose 1 Strategy • Dynamic IVC Ultrasound-Keep giving 500-1000 ml boluses of isotonic crystalloid until there is < 30% FLUIDS change in IVC size with inspiration. • Empiric Fluid Loading-Patients with severe sepsis/septic shock may require at least 6 liters of fluid during their acute resuscitation (first 6 hours of care). • If MAP is < 65 after adequate fluid loading: RE-CHECKING - Place a full sterile central line in the IJ or SC vein (femoral site only if neck line not feasible); - Start vasopressors; titrate to a MAP ≥65; MAP - Consider switching to invasive protocol. Send repeat lactate when above goals are accomplished (Send a 2nd lactate at 3-hour mark, if not already sent) • If lactate has cleared by ≥ 10 % (or is not rising if original lactate was ≤ 2 mmol/L), go to disposition • If lactate is rising or has cleared by < 10%, choose 1 option: If Hb < 7: transfuse 1 unit of PRBC or Additional Fluids: if patient had empiric fluid loading, give an additional liter of TISSUE crystalloid or OXYGENATION Inotropes: especially if heart appears hypodynamic on echo. If calcium is low, replete that first. If not, administer dobutamine 5-20 mcg/kg/min. or If Hb 7-10: consider transfusion. Especially in elderly patients or patients with coronary artery disease Send 3rd lactate, if it still has not cleared by ≥10%, continue with the above, trending lactates every 1‐2 hours until these two goals are met or switch to invasive strategy (Send 3rd lactate at the 6-hour mark, if not already sent) • Patients should get ICU consultation. If not an ICU candidate, should go to appropriately monitored DISPOSITION bed. • Periodically recheck patient for MAP ≥ 65, good mental status, and good urine output • Consider trending lactate every Q 2-4 hours. If it starts rising again, restart protocol These protocols are for informational purposes only. Please review with your institution before using clinically. .

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SEPSIS: A GUIDE FOR PATIENTS & RELATIVES CONTENTS ABOUT SEPSIS ABOUT SEPSIS: INTRODUCTION P3 What is sepsis? In the UK, at least 150,000* people each year suffer from serious P4 Why does sepsis happen? sepsis. Worldwide it is thought that 3 in a 1000 people get sepsis P4 Different types of sepsis P4 Who is at risk of getting sepsis? each year, which means that 18 million people are affected. P5 What sepsis does to your body Sepsis can move from a mild illness to a serious one very quickly, TREATMENT OF SEPSIS which is very frightening for patients and their relatives. P7 Why did I need to go to the Critical Care Unit? This booklet is for patients and relatives and it explains sepsis P8 What treatment might I have had? and its causes, the treatment needed and what might help after P9 What other help might I have received in the Critical Care Unit? having sepsis. It has been written by the UK Sepsis Trust, a charity P10 How might I have felt in the Critical Care Unit? which supports people who have had sepsis and campaigns to P11 How long might I stay in the Critical Care Unit and hospital? raise awareness of the illness, in collaboration with ICU steps. P11 Moving to a general ward and The Outreach Team/Patient at Risk Team If a patient cannot read this booklet for him or herself, it may be helpful for AFTER SEPSIS relatives to read it. This will help them to understand what the patient is going through and they will be more able to support them as they recover.
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